Provider Demographics
NPI:1578053245
Name:KING, ANTONINA
Entity Type:Individual
Prefix:MS
First Name:ANTONINA
Middle Name:
Last Name:KING
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 265
Mailing Address - Street 2:
Mailing Address - City:LOYALTON
Mailing Address - State:CA
Mailing Address - Zip Code:96118-0265
Mailing Address - Country:US
Mailing Address - Phone:530-993-6746
Mailing Address - Fax:530-993-6759
Practice Address - Street 1:704 MILL STREET
Practice Address - Street 2:
Practice Address - City:LOYALTON
Practice Address - State:CA
Practice Address - Zip Code:96118
Practice Address - Country:US
Practice Address - Phone:530-993-6746
Practice Address - Fax:530-993-6759
Is Sole Proprietor?:No
Enumeration Date:2018-05-17
Last Update Date:2018-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator